She performed complex breast reconstruction surgeries. But was she qualified?

RICHMOND, Va. — Three Virginia women with different breast reconstruction stories share a common claim: their surgeon breached the standard of care and was not qualified to perform their procedures.

"There was a lump underneath my arm the size of a softball that shouldn't have been there," said Audrey Andrews, a former patient of Dr. Sasa Grae Espino.

"Shame on you, shame on you. I can't even cry anymore because I am just so mad," said Mandy Moore, another former patient.

"I would like Dr. Espino to know that I really trusted her and I felt comfortable putting my life in her hands, and now she has torn down my self-esteem and my self-image," said Tanya Patterson, also a former patient.

CBS 6 has shared their stories over the past few months. Their lawsuits are among 17 now filed against Espino, the Richmond Breast Center, and in some cases, Chippenham Johnston Willis Hospital.

CBS6's Melissa Hipolit previously showed Dr. Lewis Ladocsi, a board-certified plastic surgeon with Richmond Plastic Surgeons, the medical records of Moore and Andrews.

"I've got grave concerns because this never should have happened," Ladocsi said.

Espino's lawyers say her "specialized fellowship, education, training and surgical experience qualifies her to perform breast reconstruction surgeries."

According to Virginia Board of Medicine practitioner information, Espino completed a general surgery residency at VCU in 2016 and a breast surgical oncology fellowship at Northwestern in 2017.

In a promotional video posted on Facebook in October 2021 by HCA Virginia's Spotsylvania Regional Medical Center, Espino referenced her training.

"I also did implant reconstruction training at Northwestern, meaning I do my own implant reconstruction. What that means for patients is they don't have to go to so many different surgeons," Espino said in the video.

Espino's lawyers say during the fellowship, Espino was trained by surgical oncologists and plastic surgeons to perform breast oncologic and reconstructive surgery. She also received an Oncoplastic Surgery Certification from the National Consortium of Breast Centers in 2023, according to her lawyers..

Hipolit asked Dr. Anne Peled what exactly oncoplastic breast surgery entails.

Peled is a breast cancer and breast reconstruction surgeon in San Francisco who is both a board-certified plastic surgeon and fellowship-trained in breast surgical oncology.

"Many breast surgeons do get some level of oncoplastic training, and that's usually going to be smaller things like you did a lumpectomy and you don't want to leave them with a defect. But anything beyond that — things like placing implants, doing fat grafting, doing flaps — all of that falls into a plastic surgeon purview and is really not part of a breast cancer surgeon training program in the U.S.," Peled said.

When asked how someone gets the training to do that type of work in the United States, Peled explained: "You do a plastic surgery residency or fellowship. You could as a general surgeon do a two or three-year plastic surgery fellowship, but that is the only way you are going to get trained to do that type of breast reconstruction in the U.S."

Espino is a board-certified general surgeon but not a board-certified plastic surgeon, and she has not done a plastic surgery fellowship, according to the Virginia Board of Medicine's practitioner information website.

"When we say breast surgeon in this country, we really mean you are a breast cancer surgeon. The bread and butter procedures would be lumpectomies, mastectomies, lymph node surgery and sometimes small amounts of lumpectomy reconstruction called oncoplastic surgery," Peled said.

She said a breast surgery fellowship like Espino's typically includes a one-month rotation with plastic surgery.

The Society of Surgical Oncology’s “Interdisciplinary Breast Surgical Oncology Fellowship Program Requirements” from 2019 highlight a “minimum of one month of plastic and reconstructive surgery as a formal rotation or time equivalent."

"The idea isn't you're going to be trained after one month to then come out and do that in your practice on your own. It's really exposure, but it's not part of your training that that is a core technique you're going to be able to do," Peled said.

When asked if it's possible to get in enough practice during such a fellowship to be able to do that type of work right away, Peled responded: "This is something you've really got to be putting in the work day in, day out. That is why plastic surgery residency is years — this isn't something we can figure out how to do in a month."

As for an oncoplastic surgery certification like Espino received, Peled explained: "Right now, having an oncoplastic certification doesn't get you anything in terms of officially being able to do any kind of procedure, to be honest. It's not something you can take to a credentialing board at a hospital. It's not like having a board certification or fellowship training."

Peled is a two-time breast cancer survivor herself. Although her unique training qualifies her to do complex procedures, she chose a breast cancer surgeon for her mastectomy and a plastic surgeon for her implants.

"That is really the standard way people would do it in this country, and I felt really great about my team," Peled said.

When asked how many people are properly trained and qualified to do both the cancer aspect and reconstruction aspect in this country, Peled said: "I don't think it's any more than 10. It's very unusual in this country for sure. But what's not unusual is so many centers have someone who does my two parts as two people very well."

Espino left the Richmond Breast Center at the end of 2024.

According to the center's website, the two breast surgeons that work there now partner with board-certified plastic surgeons to provide care.

Implant reconstruction, lat flaps, breast reductions, liposuction and fat grafting — which are all procedures the various lawsuits claim Espino performed — are not listed under services the breast surgeons at the center now provide.

Because Espino's lawyers told us she was credentialed at multiple area hospitals to perform breast reconstruction, we wanted to know which ones.

We asked VCU Health and they told me she had never been credentialed at VCU Medical Center.

CBS6 has asked Bon Secours on multiple occasions but we have never received a response.

A spokesperson for HCA Capital Division previously told us Espino's request for privileges was carefully reviewed by credentials and medical executive committees.

CBS 6 is committed to sharing community voices on this important topic. Email your thoughts to the CBS 6 Newsroom.

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